Background: Liver cancer is currently the second-most common cause of cancer-related deaths worldwide and hepatocellular carcinoma (HCC) accounts for more than 90% of liver cancers. Patients with terminal HCC are those presenting with very poor Eastern Cooperative Oncology Group (ECOG) Performance Status 3–4 with tumors beyond the transplantation threshold. Their management of terminal HCC is only palliative support. Oncoxin is a nutritional supplement that is used as an over-the-counter nutritional prophylaxis for cancers. Our aim was to evaluate the effect of Oncoxin in terminal HCC patients along with the best supportive care (BSC), comparing that to the terminal-stage HCC patient only treated with BSC to determine the survival outcome as well as performance status, assessed by the ECOG Performance Status Scale. Materials and methods: This was a randomized control trial conducted at the Hepatology Department, Bangabandhu Sheikh Mujib Medical University (BSMMU) from December 2019 to February 2021. A total of 60 patients were included (30 patients for Oncoxin with BSC and 30 patients for BSC only) and randomized into two groups. They were followed up for 3 months. Results: In this study, it was observed that at 60 days, eight (26.7%) patients survived in the Oncoxin group and one (3.3%) patient survived in the BSC group. The difference was statistically significant (p <0.05). However, the Oncoxin administration had no survival benefit at 30 and 90 days follow up. After 30 days of treatment, a comparison of ECOG Performance Status between groups showed that all 12 (100%) patients in the Oncoxin group were in grade 3, while in the BSC group, four (44.4%) patients were in grade 3 and five (55.6%) patients were in grade 4. These differences were statistically significant. Conclusion: The study shows that Oncoxin appears to increase the survival of some, but not all, patients with terminal-stage HCC. The improvement of ECOG Performance Status was also observed.

Background: Substance abuse and its associated problems are a global concern. Substances, such as tobacco, alcohol, cannabis, and various allopathic drugs have been widely abused by students for various reasons despite their known ill effects. Aim and objective: Prevalence and pattern of substance abuse among the medical students in a medical college of Kolkata during coronavirus disease (COVID-19) pandemic. Material and methods: It is a hospital-based, cross-sectional study. This is carried out in ESI-PGIMSR, ESIC Medical College and Hospital, Joka, Kolkata. Data were collected after obtaining due consent from the Institutional Ethics Committee of our institute. Students pursuing MBBS constitute the study population. A structured questionnaire created by Google forms, designed, and validated in-house was circulated online to obtain the information. Results: Details of the demographic pattern showed 72 of them were female students and the rest were male and their age group varied between 21 and 23 years. Thirty-four of them were staying in the rural area whereas the rest were urban pupils. Most of the participation came from 1st-year students (83) and the least came from final year (4th or 3rd Prof Part 2) students. The number of participants was only 10. A significant statistical association was found between male gender and marijuana abuse (p = 0.043), and male gender with smoking (p = 0.002). The association of the status of being a hostelite with marijuana abuse (p = 0.015), alcohol abuse (p = 0.065), and with smoking (p = 0.012) was also found to be statistically significant. The prevalence of smoking and marijuana abuse was observed to progressively increase from the 1st year (3.61%) to the final year (smoking = 40%, marijuana = 50%). Conclusion: Further research is needed from Eastern India to understand patterns of substance use among medical students, to identify important determinants, and reinforce protective factors.

Malnutrition is a pathological state due to either excess or deficient intake of one or more essential nutrient. It can be undernutrition or overnutrition (obesity). Adult undernutrition is often underestimated and undertreated. There are many causes of undernutrition in adults like poverty, malabsorption syndrome, chronicinfection, immunocompromised state, and worm infestation in adults. This is a case report of immunocompetent adult malnutrition due to worm infestation. Strongyloidiasis is often underestimated due to its subclinical presentation. It may present as acute respiratory distress syndrome (ARDS), AGE, and hyperinfection syndrome based on different phases; it acquires in the host. This patient was presented with hyperinfection syndrome and diagnosed with Strongyloides stercoralis infestation by upper gastrointestinal endoscopic biopsy and histology and stool examination. Patient was treated with specific antihelminthic and supportive therapy and recovered substantially.

Lemierre's syndrome: More than a historic curiosa, a prepenicillin era illness characterized by disseminated abscess and thrombophlebitis of internal jugular vein after infection of the oropharynx. The predominant pathogen is a gram-negative anaerobic bacillus Fusobacterium necrophorum. A prompt clinical diagnosis is of utmost importance for a favorable prognosis in the management of this patient. Here we present a case of Lemierre's syndrome in a middle-aged uncontrolled diabetic male where the unusual and atypical clinical manifestation posed a mounting challenge in the diagnosis of this case. And, the peculiarity in this case was that the causative organism was Klebsiella pneumoniae that is not known to cause Lemierre's syndrome typically. To date, only a few other cases have been reported where the organism was K. pneumoniae.

The combination of one-and-a-half syndrome and facial nerve palsy is a rare neurological syndrome called eight-and-a-half syndrome, described first by Eggenberger in 1998. The one-and-a-half syndrome is characterized by ipsilateral conjugate horizontal gaze palsy (the “one”) and an ipsilateral internuclear ophthalmoplegia (the “one-half”). A single unilateral lesion involving the paramedian pontine reticular formation or the abducens nucleus (causing the conjugate gaze palsy) with the interruption of internuclear fibers of the ipsilateral medial longitudinal fasciculus along with the region of facial colliculus results in eight-and-a-half syndrome. The occlusion of perforating artery to the pons resulting in pontine infarction is the commonest cause of this syndrome. The rare causes include demyelination, tumor, infection, and brainstem vasculitis. We describe here a case of eight-and-a half syndrome in a 50-year old gentleman due to pontine infarct, who also had cerebrovascular disease risk factors.